Transforming Pediatric Pain Care: A National Learning Health System Approach in Action

Despite Canada’s global leadership in pediatric pain research, many children across the country continue to suffer from undertreated and preventable pain. To bridge the gap between research and practice Dr. Kathryn (Katie) Birnie, Associate Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at the University of Calgary, led the development of the world’s first national health standard for Pediatric Pain Management (CAN/HSO 13200:2023).  

Now committed to seeing Pediatric Pain Management (PedPM) standard implemented in hospitals across the country, for Dr. Birnie this work is more than academic. “I’m driven by research that’s responsive to real-world needs, that promotes equity, and that has the potential to make a national impact,” she explains. 

At the core of this initiative is a commitment to co-design as a foundational principle of a Learning Health System (LHS) approach, ensuring that patients, caregivers, and healthcare professionals are not just consulted but actively engaged throughout the development of the PedPM Implementation Guide.  Together with families with lived experience, multidisciplinary health professionals, quality improvement experts, and hospital leaders from across Canada, Dr. Birnie’s team is developing an Implementation Guide to facilitate the widespread uptake of the Pediatric Pain Management standard in diverse hospital settings.  The team is applying established implementation science frameworks to identify and address barriers, facilitators, and effective strategies for implementing the standard. 

A Learning Health System Approach: Family, Health Professional, and Health Systems Leader Co-Design

By embedding co-design throughout, the project ensures that the Implementation Guide is not only evidence-informed but also deeply attuned to the lived experiences and operational realities of those it aims to serve.  The team has employed a range of strategies to support this inclusive process, including:

• Hosting virtual and in-person co-design sessions with diverse end-user groups.
• Applying implementation science frameworks to guide structure and strategy: COM-B, TDF, Behaviour Change Wheel, and ERIC taxonomy.
• Conducting pre/post surveys and qualitative synthesis.
• Ensuring equity-oriented sampling to reflect diversity in geography, hospital type, role, and identity.
• Iterative development with usability testing and feedback loops to ensure continuous refinement.

This approach captures the nuanced needs of different hospital settings, including rural and urban contexts, and reflects a broad spectrum of perspectives across roles, identities, and geographies. This process not only enhances usability but also strengthens the guide’s potential for equitable impact.

Toward More Equitable, High-Quality Pain Care

As a National Standard of Canada, the Pediatric Pain Management standard aligns with a LHS approach as it simultaneously addresses health professional actions as well as necessary systems-level supports to enable real-time learning and guide decision-making.  By supporting hospitals in adopting the standard, the Implementation Guide aims to:

• Reduce pain and its long-term consequences for children and families.
• Improve healthcare experiences and outcomes.
• Equip healthcare professionals and organizational leaders with effective tools and strategies.
• Decrease the financial burden on families and the healthcare system.

A central focus of implementation efforts is to advance equity in pediatric pain care across Canada, ensuring that every child receives the best possible pain care, every time, at any hospital. 

Looking Ahead

Having completed co-design sessions, the team is now working to develop the content of the Implementation Guide. Following completion of a prototype of the Implementation Guide, they will conduct several end-user testing sessions prior to finalization, translation to French, and a public launch. 

Dr. Birnie’s advice for others undertaking similar projects: “Partner with others!” she says, having leveraged partnerships with Solutions for Kids in Pain (SKIP), The Center for Implementation, and hospitals across Canada to include diverse perspectives and expertise. Together, they are laying the foundation for a future National Learning Collaborative dedicated to improving pediatric pain care across Canada.

To learn more visit:

www.kidsinpain.ca
www.partneringforpain.com
Social: @kidsinpain | Hashtag: #ItDoesntHaveToHurt